Shawn Mathew, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2951000843 Issued in MI

Practice address

952 Harbins Rd Ste 401
Dacula, GA 30019-2824

Phone

(470) 268-3056

NPI assigned

Mar 19, 2021

Last updated

Feb 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Dental Professionals, PC

  dba Palm Creek Dental Care

  • General Practice Dentistry
  • Dacula, GA
  • NPI 1093578718
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1003492281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "952 HARBINS RD STE 401",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300192824",
            "telephone_number": "470-268-3056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "952 HARBINS RD STE 401",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300192824",
            "telephone_number": "470-268-3056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5462 Memorial Dr Ste 103",
            "address_purpose": "LOCATION",
            "city": "Stone Mountain",
            "state": "GA",
            "postal_code": "300833239",
            "country_code": "US",
            "telephone_number": "770-469-1331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2700 Martin Luther King Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482082576",
            "country_code": "US",
            "telephone_number": "313-494-6873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "SHAWN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-19",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2951000843",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Mariney, LPC
• Kayla Marshall, PHARMD
• Kenya Marthone
• Uyen DO Maschek, DMD
• Deena Suzanne Massengale, PHARMD, RPH
• Aliya Matthews, DPM
• Gina M Maxey, M.D.
• Amie Patricia May, NP
• Anke Mbapeh
• James Joseph MC Farland, M.S., M.D.

• General Practice Dentistry in Dacula, GA
• Providers in Dacula, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.